Medication warnings
Certain veterinary medications for other conditions may seriously affect diabetic patients. This list is provided because some of these medications don't mention their side effects on diabetics in their literature. Many drugs used in veterinary medicine are also used in human medicine under a differently-trademarked name. Learning the human pharma name (if applicable) of the drug can often give you additional information regarding possible side effects and how the drug may affect patients with diabetes. Human pharma drugs provide this information--for some reason, veterinary drugs don't always. Warnings: May raise blood glucose levels Heartworm and flea/tick prevention Heartworm and flea/tick prevention medications are known to produce temporary high blood glucose levels in some diabetic dogs. In the affected animals, glucose levels return to normal a few days after the medication is used--loss of control being temporary. Just as all diabetics are not troubled with post-prandial spikes or dawn phenomenon, not all diabetic pets react to these medications in this way. No pharmaceutical company's products of this type contain advisories regarding the temporary elevation of blood glucose. Heartworm Prevalence of Heartworm Worldwideis a global problem, with areas on all continents except Antarctica affected and is a disease that is far easier to prevent than to cure. Should your pet be affected by this, a talk with your vet is in order. Increasing insulin doses to counter this temporary situation may cause hypoglycemia once the systemic medication level has lowered. The phenomenon also does not mean your pet has ceased to respond to the insulin you currently use. Since there are no formal label warnings, he/she needs to be aware that there are temporary side effects for these drugs which apply to some diabetics. The same is true for flea and tick removal products, both professional and over the counter; they are also capable of producing this unwanted effect after use in some diabetic animals. Other Medications Epinephrine, or adrenalin, is a hormone present in all of us; most medical literature refers to it simply as the "fight or flight" hormone. It is what gives one that "extra boost" when needed to either escape danger or stand one's ground. A common medical use of epinephrine is to combat severe allergic/asthmatic reactions. Many people with life-threatening reactions to things like bee stings, etc., are never without their EpiPen. It's a pre-loaded injection of epinephrine to be used in an emergency. When someone with diabetes needs treatment with epinephrine, it counters the effects of the insulin and hyperglycemia is the result. Nicotinic Acid or Niacin, given to lower cholesterol. Phenobarbital and phenytoin (Brand name for phenytoin is Dilantin), commonly used in treating epilepsy and other nervous system disorders. Thyroid medications used as replacement hormone therapy for those with insufficient thyroid production or who have had the glands removed. Also see below under diuretics/heart medications for some diuretics which can cause hyperglycemia. Contraindicated: May complicate or even promote diabetes Steroids Oral or injected steroids such as cortisol are known to raise blood sugar and even sometimes cause diabetes. Talk to your vet -- sometimes steroids are still the best (or only) treatment for a condition and can be compensated for with known diabetes. Inhaled steroids for asthma may be tolerated by diabetics better than oral or injected. Using steroids--orally, injected or even topically (applied to the skin as an ointment or cream)--can elevate blood glucose levels. During treatment and for a period after treatment with steroids ends, higher doses of insulin may be necessary. More brand names for corticosteroids are : prednisone, Decadron and Kenalog. One brand name for injectable prednisone (methylprednisolone) is Depo-Medrol. Hormones The drug Ovaban (megestrol acetate) (progestin--female hormone) is approved for use in dogs to end heat cycles. It has also been prescribed for behavioral problems in both dogs and cats, since it is the opposite of testosterone (male hormone). The drug has also been prescribed for some feline skin conditions. Its use with cats has been proven to cause diabetes much of the time; they are also at risk for developing Addison's disease as a result of the drug. It is contraindicated for use in dogs with diabetes. These types of hormones, when prescribed for diabetics, can be "double problems". The progestin-type hormones themselves, by nature, raise blood glucose; use of them can also mean the body may begin producing excess growth hormones, which causes insulin resistance. Antibiotics The antibiotic Tequin (gatifloxacin), has now been required to strengthen its labeling regarding hyperglycemia and hypoglycemia possibilities when used. The new labeling contraindicates the antibiotic for anyone with diabetes. The producer of Tequin, Bristol-Meyers Squibb, indicated on May 1, 2006, that it plans to discontinue the manufacturing and distribution of Tequin. Current stocks of the antibiotic have NOT been recalled, so the drug is still on some medical/pharmacy shelves. Bristol-Meyers Squibb indicates they will continue to ship Tequin until June 1, 2006. A watchful eye on what antibiotic has been prescribed is needed. Warnings: May have other adverse side effects Antibiotics Our pets may be prescribed antibiotics for various reasons, such as a dental procedure or a urinary tract infection. A common full-spectrum antibiotic given for dental procedures is Clavamox, which is available in both tablet and liquid form. The liquid form is sweet, but the sweetness is from an artificial sweetener and should not affect blood glucose. The pill can be crushed and added to wet food if the animal is difficult to pill. Some animals, like some humans, get diarrhea on antibiotics. This can be minimized by the concurrent administration of a probiotic like Culturelle, which is available at vitamin stores. Consult with your veterinarian on the appropriate amount of probotic for your animal. Some caregivers report higher blood glucose levels while their pet is on antibiotics. The antibiotic oxytetracycline can cause low blood sugar or hypoglycemia. The medication is found in oral form under the (human) brand name Terramycin. The antibiotic is also able to be given by injection and found in ointment under the Terramycin brand name and the (human) brand name Terak for use in the eyes. Chloramphenichol, brand name Chloromycetin, can lower blood glucose. Another class of drugs used to fight various infections are called Sulfa Drugs (many brand names--Gantrisin, Septra, Bactrim are some). They are often used similarly to antibiotics for this purpose. Sulfa drugs can cause hypoglycemia, even in those without diabetes. Diuretics/Heart Medications Digoxin (aka Lanoxin and other brand names), furosemide (aka Lasix, Salix and other brand names), can interact with insulin. Though its primary use is for treatment of diabetes, insulin is useful to both people and pets suffering from an overdose of potassium--too much of it in the blood. The medical term for this is hyperkalemia. Potassium ions enter the cells through glucose--insulin helps bring this life-saving change about. Regarding furosemide (human brand names Lasix & Myrosemide--veterinary brand name Salix) and bumetantide (human brand name Bumex, shown below), they belong to a class of directics known as loopdiuretics. This type of medication can cause hyperglycemia for those with diabetes. Both digoxin and furosemide drain potassium from the system, along with the excess fluids they are prescribed to eliminate. Not all diuretics have this potassium-robbing action; those which don't are known as potassium-sparing diuretics. These drugs in combination with also necessary insulin can bring about a lower than normal potassium level known as hypokalemia. The problem can be prevented or solved by a prescription for a potassium suppliment (K-Dur is just one brand name). Other diuretics such as bumetanide (human brand name) Bumex and thiazide based diuretics/ hypertension medications can cause hyperglycemia. There are many human brand names for this class of drugs at this link. More brand names for diuretics which can raise glucose levels are: Diuril, hydroDIURIL,Esidrix, Diamox, Hygroton, Edicrin. Hypertension drugs known generically as Diazoxide (Brand names: Hyperstat, Proglycem)are used not only for cases of high blood pressure, but also for treating non-diabetic hypoglycemia.This class of medication will raise blood glucose levels. Propanolol (human brand name Inderal) is a drug used to fight hypertension (high blood pressure) and heart disease in people. The drug belongs to the beta-blocker class. They work by blocking beta receptors in the heart for noradrenaline and adrenaline. Anyone with diabetes who uses them needs to be especially careful, because they also can block some of the normal symptoms of hypoglycemia and may make a hypoglycemic episode last longer. Beta blockers increase the risk of hyperglycemia in those with diabetes. Other generic and human brand names of Beta-blockers are: acebutolol--Sectral, atenolol--Tenormin, betaxolol--Kerlone, biprosolol--Zebeta, carteolol--Cartrol, labetalol--Normodyne, metoprolol--Lorressor, nadolol--Corgard, oxprenolol--Trasicor, penbutolol--Levatol, pindolol--Visken, propranolol--Inderal, sotalol--Sotacor, timolol--Blocadren. Methyldopa, brand name Aldoril, used in treating hypertension. can lower blood glucose levels. Can Lower Blood Glucose Phenylbutazone, brand name, Butazolidin, used in treatment of arthritis, can lower glucose levels. Chlofibrate (Brand name Atromid-S), for high cholesterol. Aspirin can be a factor in low blood sugar, or hypoglycemia. Coumarin-based anticoagulants (Brand name Dicumerol), used to prevent blood clots. For antibotics and sulfa drugs which lower blood glucose, see Antibiotics section above. All heart/hypertension/diuretics, some of which do lower blood glucose levels are also listed above in their own section. Other False Testing Results Antibiotics cephalexin (brand name Keflex)and enrofloxacin (brand name Baytril) have been shown to provide less than accurate (false positives and false negatives) urine test results (4 common OTC urine test kits used in study) when administered to non-diabetic dogs. When using either of these antibiotics and urine testing strips, the results may be totally inaccurate, thus invalidating their use for diabetes monitoring while said drugs are being used. Antibiotics Tetracycline (human brand names Helidac, Sumycin) can cause false urine glucose test results. Doxycycline (human brand names Doryx, Doxy 100, Monodox, Vibramycin, Vibra-Tabs) can do the same. Pets taking Vitamin C supplements may have the following false test results: Blood Chemistry: * Decreased blood glucose and cholesterol test levels. Urine Testing: * False high urine glucose test results (With urine test brand name Clinitest). * False low urine glucose test results (With urine test brand name Clinistix). If your pet is taking any type of vitamin supplements, it should be noted on his or her medical records. Knowing that he/she is using them means being able to factor them into interpretations of test results. External Links *Commonly Used Veterinary Drugs and Dosages By Species *Therapeutic Drug Monitoring--Tailoring Drug Dosages to the Individual Patient *Multidrug Sensitivities in Dogs--How They Can Be Gene-Related *Start Page to US Pharmacopeia--Information on Over 9,000 Rx & OTC Drugs References Category:ComplicationsCategory:TipsCategory:Treatments